Migration and Erosion of Coils from Previous Pelvic Embolization

Transarterial embolization (AE) can be a lifesaving procedure for severe hemorrhage associated with pelvic fractures. The purpose of this study was to identify demographic and radiographic findings that predict the need for embolization. We performed a retrospective review of all patients with at least one pelvic fracture and admission to the intensive care unit over a 35-month period. Computed tomography (CT) and pelvic radiographs were reviewed. Patient demographics, outcomes, time to angiography, and whether or not embolization was performed were determined. Statistical analysis was used to determine factors associated with the need for AE. Of the 327 total patients with pelvic fractures, 317 underwent CT scanning. Forty-four patients (13.5%) underwent angiography and 25 (7.6%) required therapeutic embolization. There were 39 total deaths (11.6%) with five deaths related to pelvic hemorrhage (1.5%). Multivariate analysis revealed that age older than 55 years (odds ratio [OR], 1.06; P < 0.001), systolic blood pressure less than 90 mmHg in the emergency department (OR, 11.64; P = 0.0008), and CT extravasation (OR, 147.152; P < 0.0001) were significantly associated with the need for embolization. Contrast extravasation was not present in 25 per cent of patients requiring therapeutic AE. The presence of contrast extravasation is highly associated with the need for pelvic embolization in patients with pelvic fractures, but its absence does not exclude the need for pelvic angiography.

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Utility of Plain Film Pelvic Radiographs in Blunt Trauma Patients in the Emergency Department

The American Surgeon ◽

10.1177/000313480607201025 ◽

2006 ◽

Vol 72 (10) ◽

pp. 951-954 ◽

Cited By ~ 13

Author(s):

Amal Kamil Obaid ◽

Andrew Barleben ◽

Diana Porral ◽

Stephanie Lush ◽

Marianne Cinat

Keyword(s):

Emergency Department ◽

Ct Scan ◽

Blunt Trauma ◽

Injury Severity ◽

Plain Film ◽

Pelvic Fractures ◽

Trauma Patients ◽

Pelvic Radiographs ◽

Highly Sensitive ◽

Pelvic Embolization

The objective of this study was to evaluate the utility and sensitivity of routine pelvic radiographs (PXR) in the initial evaluation of blunt trauma patients. A retrospective review was performed. One hundred seventy-four patients with a pelvic fracture who had computed tomography (CT) and PXR were included (average age, 36.1; average Injury Severity Score, 16.3). Nine (5%) patients died. Five hundred twenty-one fractures were identified on CT. One hundred sixteen (22%) of these fractures were missed by PXR. Eighty-eight (51%) patients were underdiagnosed by PXR alone. The most common fractures missed by PXR were sacral and iliac fractures. Eight patients required angiograms, with four undergoing therapeutic pelvic embolization. Forty-seven (27%) patients were hypotensive or required a transfusion in the emergency department. These patients were more likely to require an angiogram (17% vs 0%, P < 0.0001) and were more likely to require embolization (9% vs 0%, P < 0.001). This study demonstrates that CT scan is highly sensitive in identifying and classifying pelvic fractures. PXR has a sensitivity of only 78 per cent for identification of pelvic fractures in the acute trauma patient. In hemodynamically stable patients who are going to undergo diagnostic CT scan, PXR is of little value. The greatest use of PXR may be as a screening tool in hemodynamically unstable patients and/or those that require transfusion to allow for early notification of the interventional radiology team.

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Blunt Thoracic Aortic Injury

The American Surgeon ◽

10.1177/000313480807401033 ◽

2008 ◽

Vol 74 (10) ◽

pp. 1033-1037 ◽

Cited By ~ 1

Author(s):

Elizabeth R. Benjamin ◽

Areti Tillou ◽

Jonathan R. Hiatt ◽

H. Gill Cryer

Keyword(s):

Injury Severity ◽

Aortic Injury ◽

Diagnosis And Treatment ◽

Successful Outcome ◽

Operative Repair ◽

Blunt Thoracic Aortic Injury ◽

Thoracic Aortic Injury ◽

Pelvic Embolization ◽

Life Threatening ◽

Level I

Blunt thoracic aortic injury (BAI) is a rare but often fatal injury that occurs with severe polytrauma. Immediate diagnosis and treatment of BAI are essential for a successful outcome. We reviewed our experience with 20 patients with BAI treated at a Level I trauma center between 1995 and 2006. The mean Injury Severity Score was 38 ± 14 and 14 patients had an abnormal Glasgow Coma Score; associated injuries included abdomen in 13 patients, extremity in 12, and head in six. Chest x-ray (CXR) findings were suggestive of aortic injury in 15 patients, equivocal in three, and showed no evidence of aortic injury in two. Diagnosis was made by CT angiography (CTA) in 17 patients, transesophageal echocardiography (TEE) in two, and formal angiography in one. Sixteen patients underwent operative repair of BAI. Of these, eight also underwent laparotomy, six had operative repair of extremity fractures, and three had pelvic embolization. Five patients died, three of whom were treated nonoperatively, and length of hospitalization in survivors was 32 ± 20 days. BAI is rare and often associated with multiple life-threatening injuries complicating diagnosis and treatment. Our data support the aggressive use of CTA even when classic CXR findings are not present. When CT must be delayed for abdominal exploration, intraoperative TEE is useful.

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